Organization
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC
Active
Parent organization
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC
Other names
SoutheastHEALTH Family Medicine of Dexer
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC
Authorized official
PAULA E HARRIS (VICE PRESIDENT REGIONAL OPERATIONS)
(573) 778-0020
Entity
Organization
Contact information
Practice address
1200 N ONE MILE RD, DEXTER, MO 63841-1000
(573) 624-7575
Mailing address
PO BOX 368, DEXTER, MO 63841
(573) 624-3165
(573) 624-3157
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
509684809
—
MO
01
—
DC5315
RAILROAD MEDICARE
MO
Enumeration date
12/15/2006
Last updated
09/22/2014
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